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Multiple Personality Disorder: The Perplexing
Mental Health Illness
One of the most perplexing mental health
illnesses is Dissociative Identity Disorder (DID). This disorder is best
recognized as multiple personality disorder, a disorder that came to the
public’s attention through movies such as “The Three Faces of Eve” and
“Sybil”. Estimates vary, but only about 1% of the general population and
anywhere from 5 to 15% of the psychiatric community suffers from multiple
personality.
There has always been controversy surrounding this diagnosis. Does the
personality (alter) represent a delusion or something real? Multiple
personality disorder is also something that has no objective criteria to
observe, so the diagnosis seems very subjective. Some people believe that it
is all made up and is produced by a therapist and an overly suggestible
client.
For those who suffer from Dissociative Identity Disorder (DID), the
disorder, real or delusional, wrecks havoc in their lives. Getting up in the
morning and deciding what to wear is a difficult time because each alter may
have his/her own opinion about what to wear. The choice of foods at meal
time can be quite problematic as well. In fact, any situation requiring a
decision or choice can be quite trying as one tries to sift through all the
opinions heard in one’s head.
Just how did this splitting come about?
Some people theorize that extremely traumatic events in which the child has
difficulty dealing with can cause splitting. By dissociating when this event
occurs, the child psychologically separates from the event to such an extent
that they may not have direct recall as to what happened. As the child
continues to use this ingenious method of escape, this defensive coping
strategy becomes habituated and they begin to use it whenever they feel
threatened. It now does not have to be triggered by an abusive or
life-threatening situation. Over time the repetitive nature of the
dissociation may result in separate parts of self that take on identities
all their own.
What happens in therapy?
Integration is usually the goal. Some multiple personalities fear this goal.
this is because the internal dynamics change when integration of an alter
occurs and it becomes almost disorienting. Leaving everything the same feels
comfortable and the person may feel like the alter is "done away with" or is
lost. This is not the case. As skills training helps the multiple
personality learn ways to deal with situations without involving the alter,
the function the alter fulfills is no longer there. This aspect of the
person's personality becomes a part of them, rather than the feared loss.
Working through the trauma that caused each split is also an issue that is
addressed in therapy.
Therapy is not a quick fix. It is outside the boundaries of most insurance
plans, because therapy usually is measured in years and not weeks or months.
Integration and emotional health is attainable and this hope for emotional
stability is what sustains many through the lengthy therapy.
Author - Evelyn Wenzel, LCSW, CAP
Contact us at (407) 248-0030.
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The year 2000 Diagnostic & Statistical
Manual for Mental Disorders (DSM-IV-TR) provides criteria for
diagnosing ADHD. The criteria are presented here in modified
form in order to make them more accessible to the general
public. They are listed here for information purposes and should
be used only by trained health care providers to diagnose or
treat ADHD.
DSM-IV Criteria for ADHD
I. Either A or B:
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Six or more of the following symptoms
of inattention have been present for at least 6 months to a
point that is disruptive and inappropriate for developmental
level:
Inattention
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Often does not give close attention to
details or makes careless mistakes in schoolwork, work, or
other activities.
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Often has trouble keeping attention on
tasks or play activities.
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Often does not seem to listen when
spoken to directly.
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Often does not follow instructions and
fails to finish schoolwork, chores, or duties in the
workplace (not due to oppositional behavior or failure to
understand instructions).
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Often has trouble organizing activities.
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Often avoids, dislikes, or doesn't want
to do things that take a lot of mental effort for a long
period of time (such as schoolwork or homework).
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Often loses things needed for tasks and
activities (e.g. toys, school assignments, pencils, books,
or tools).
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Is often easily distracted.
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Is often forgetful in daily activities.
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Six or more of the following symptoms
of hyperactivity-impulsivity have been present for at least
6 months to an extent that is disruptive and inappropriate
for developmental level:
Hyperactivity
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Often fidgets with hands or feet or
squirms in seat.
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Often gets up from seat when remaining
in seat is expected.
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Often runs about or climbs when and
where it is not appropriate (adolescents or adults may feel
very restless).
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Often has trouble playing or enjoying
leisure activities quietly.
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Is often "on the go" or often acts as if
"driven by a motor".
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Often talks excessively.
Impulsivity
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Often blurts out answers before
questions have been finished.
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Often has trouble waiting one's turn.
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Often interrupts or intrudes on others
(e.g., butts into conversations or games).
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Some symptoms that cause impairment were
present before age 7 years.
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Some impairment from the symptoms is
present in two or more settings (e.g. at school/work and at
home).
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There must be clear evidence of
significant impairment in social, school, or work
functioning.
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The symptoms do not happen only during
the course of a Pervasive Developmental Disorder,
Schizophrenia, or other Psychotic Disorder. The symptoms are
not better accounted for by another mental disorder (e.g.
Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a
Personality Disorder).
Based on these criteria, three types of
ADHD are identified:
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ADHD, Combined Type: if both
criteria 1A and 1B are met for the past 6 months
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ADHD, Predominantly Inattentive Type:
if criterion 1A is met but criterion 1B is not met for the
past six months
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ADHD, Predominantly
Hyperactive-Impulsive Type: if Criterion 1B is met but
Criterion 1A is not met for the past six months.
American Psychiatric Association:
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. Washington, DC, American Psychiatric
Association, 2000. |
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